Is Direct Primary Care the Wave of the Future

The debate over medical care has become almost as divided as the political parties in our country. Medical insurance has become a necessary evil although the evil part isn’t just the insurance companies. Now that the government is involved, more rules have been applied, making it harder not only on the patients but on the doctors as well.

As a result, doctors are scrambling to find new ways to provide quality healthcare for their patients. One of the newest ways to do this is a medical model called Direct Primary Care.

Direct Primary Care is an alternate way for doctors and patients to interact without insurance. DPC facilities charge patients a monthly fee that covers different services. For some, a monthly fee covers any and all visits and consultations, even over the phone. For others, it also includes lab and blood work.

DPC facilities do not have to answer to insurance companies, so many of the same rules don’t apply. For example, any tests ordered by a DPC doctor are paid directly to the lab by the DPC facility. A Vitamin D Test which costs a DPC $38, has a cost of over $1000 at a local hospital. Why? Because at the hospital, the patient is paying for the people who can’t or won’t pay. The lab knows the doctor will pay, so they don’t gouge the patients.

Many DPC facilities schedule as long as an hour for patient appointments because they aren’t under the same pressure to see a certain amount of patients per day as they are with insurance companies. That’s because insurance companies don’t pay doctors unless they actually SEE the patient. That’s why a doctor won’t diagnose over the phone or just write a prescription without first seeing a patient. Also, insurance dictates that doctors see a particular number of patients within a certain amount of time, so hour-long appointments just aren’t feasible.

Some Direct Primary Care physicians will not only include phone consultation, patients may send a picture of a rash and the doctor will call in a prescription.

For the most part, Direct Primary Care is about wellness and preventative medicine. Primary care doctors provide minor procedures such as laceration repair, skin lesion removal, ingrown toenail removal, wart treatment and the like. They also handle chronic disease management such as diabetes, thyroid disorders, high blood pressure and mood disorders. For those with chronic disease or conditions such as asthma, DPC can be a lifesaver.

DPC patients still need health insurance to cover hospital emergencies and to meet the Affordable Care Act criteria. Since ACA was enacted, catastrophic insurance (high deductible, used only in case of emergency) is not as affordable as it used to be.

The argument against DPC is that patients will forgo insurance altogether especially those who are younger and don’t get sick often. The problem comes when something bad does happen and not only will they owe the medical bills, but the government will fine them for not
having insurance.

The other concern is that the more doctors turn to DPC, the less doctors there will be to fill the insurance gap. Insurance has become such a headache, that many older doctors have retired early. Many others are choosing a different path altogether. To put it in perspective, with insurance, well over 60% of doctor’s office costs are administrative, which is why DPC doctors can survive on the monthly cost alone. Many of the DPC doctors say that they don’t make as much money, but the trade off is worth it.

DPC is growing in the North Texas area and facilities are popping up in Frisco, Argyle, Roanoke, Plano, Dallas and Fort Worth with another to soon open in Flower Mound. It’s whether patients find the additional cost worthwhile that will determine its survival.